Switching to a Low-Cost Progestin May Help Reduce Endo Pain When Oral Contraceptives Won’t Work

...but progestins should not be used as a first-line treatment for endometriosis.

Key Points

Highlights:

• Switching from oral contraceptives to oral progestin to manage endometriosis-associated pain could benefit most patients. 

Importance:

• The results of this study could be used to inform women with endometriosis who do not respond to oral contraceptives.

What`s Done here?

• This prospective study assesses whether it is worth to shift to a progestin (NETA) when estrogen-progestins are not useful for pelvic pain associated with endometriosis, 
• 153 women using oral contraceptives as a treatment for endometriosis but had one or more persistent, moderate or severe pain symptoms switched to 2 mg per day of oral NETA.
• Pelvic pain assessed by two questionnaires. The health-related quality of life, psychological status, and sexual function were also evaluated before and one year after the switch.

Key results:

• The majority (70%) of women who switched from oral contraceptives to NETA treatment were satisfied with the new procedure,
• Switching from oral contraceptives to NETA treatment also resulted in a statistically significant improvement in the women’s health-related quality of life, psychological status, and sexual function. 
• 46.4 percent (58/125) reported suboptimal drug tolerability, however, their complaints were not severe enough to cause dissatisfaction, drug discontinuation, or request for surgery. 

Limitations of the study:

The investigation was not conducted under ideal experimental conditions with control groups.

Lay Summary

The majority of women with endometriosis-associated pain were satisfied to have switched to a treatment with norethisterone acetate or NETA, a synthetic, orally active progestin, when their oral contraceptive was ineffective, found a study published in the journal Reproductive Sciences.

According to the authors, this finding could be used to counsel women with symptomatic endometriosis not responding to treatment with oral contraceptives and inform their decisions on modifications of disease management.

To assess whether it was worthwhile to shift to a progestin when estrogen-progestins are not useful in managing pelvic pain associated with endometriosis, researchers led by Dr. Edgardo Somigliana at the University of Milan, Italy conducted a prospective study in 153 women. All women were using oral contraceptives as a treatment for endometriosis but had one or more persistent, moderate or severe pain symptoms. All women switched from a low-dose oral contraceptive to 2 mg per day of oral NETA.

The researchers measured the pelvic pain experienced by the women using two different questionnaires. They also evaluated the women's health-related quality of life, psychological status, and sexual function before and one year after the switch. They found that of the 125 women who remained in the study (28 women dropped out of the study), 70 percent were very satisfied or satisfied with the NETA treatment. 

Moreover, they recorded that there were statistically significant improvements in the women’s health-related quality of life, psychological status, and sexual function. 

Although 58 out of the 125 remaining patients (46.4 percent) reported suboptimal drug tolerability, their complaints were not severe enough to cause dissatisfaction, drug discontinuation, or request for surgery. 

The authors concluded that a switch from oral contraceptives to progestin could be a pragmatic solution when the former fails to control endometriosis-associated pelvic pain. However, they said that the results of this study should not lead to the systematic prescription of progestins as a first-line treatment for endometriosis, since long-term progestins may raise some safety concerns.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29303056